Provider Demographics
NPI:1295405157
Name:JEAN BAPTISTE, MEDGINE STEPHANIE
Entity Type:Individual
Prefix:
First Name:MEDGINE
Middle Name:STEPHANIE
Last Name:JEAN BAPTISTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1862 AMERICUS MINOR DR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-2183
Mailing Address - Country:US
Mailing Address - Phone:407-536-3627
Mailing Address - Fax:
Practice Address - Street 1:1862 AMERICUS MINOR DR
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-2183
Practice Address - Country:US
Practice Address - Phone:407-536-3627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
FL156941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty